Management of the Hip Complex Flashcards
Besides the labor what are two ligaments within the hip capsular?
ligamentum teres- leads to AVN if damaged
Transverse ligament- completes 180 degree rim around acetabulum
What are three major hip ligaments outside the capsule?
iliofemoral- Y ligament
pubofemoral
ischiofemoral-
What are the three bursae in the hip region that are clinically significant?
trochanteric, iliopectineal, ischiogluteal
What is connected to the trochanteric bursa?
ITB, glute med and min, greater troch.
How can you distinguish between a bursa injury and ms tendon injury?
ms injury tends to be more localized to a specific spot such as ms attachment
bursa tends to be spread in a larger area
What is connected to the iliopectineal bursa?
iliopsoas, iliopectineal eminence along superior rim of acetabulum
What is connected to ischiogluteal bursa?
common hamstring tendon and ischial tube
check for avulsion fracture
What structures are in the femoral triangle?
femoral vein, artery and nerve
What are the borders of femoral triangle?
lateral border- sartorius
medial- adductor longus
superior- inguinal ligament
floor- iliopsoas tendon
What is open packed position of hip?
greatest laxity 10-30 of flexion, 10-30 abduction, 0-5 degrees ER
What is version of the hip joint?
position in space relative to a body plane, head and neck with frontal plane
What is torsion of hip joint?
twist of bone along a longitudinal axis, head and neck with condyles
What is normal degree of inclination of femoral head is anterior relative to distal femoral condyles?
12-15 degrees
What is ante version?
angle of inclination over 15 degrees causes compensatory IR leading to shortened IR muscles and limited ER
What are functional results of ante version?
toes pointed in, increased demand on posterolateral hip and thigh soft tissues (ITB, vastus lateralis, bicep femoris), angle of gait decreased
What are common symptoms of ante version?
ITB, piriformis, trochanteric bursitis, patellafemoral dysfunction
gait- late phase supination due to progression of weight bearing forces
What is W sitting?
potential early cause of Anteversion, common in kids with low tone
What is retroversion?
angle of inclination is below 12 degrees leads to compensatory ER which limits IR and shortens ER muscles
What are functional effects of retroversion?
increases demand of anteromedial hip and thigh soft tissue structures (iliopsoas, Adductors, rectus femoris), resulting in toe out
What are common symptoms of retroversion?
iliopsoas strain, addcutor strain, psoas bursitis
gait: late phase of pronation due to progression of weight bearing forces
What happens in transverse plane during gait for toe in?
early stance- pronation, subtalar adducted
late- supination COM lateral to STJ axis
What happens in transverse plane during gait for toe out?
early stance: talus abducted, supination
late- pronation, COM medial to STJ axis
What is angle of inclination of femoral neck in frontal plane?
125 degrees
What is coxa valga?
angle of inclination greater than 125 degrees, leading to femoral abduction and genu varum
What are functional implications of coxa valga?
narrow base of support, medial knee compression lateral knee tension, greater need for STJ pronation during gait to bring calcaneus to ground
What is coxa vara?
angle of inclination less than 125 degrees leading to femoral adduction resulting in genu valgum
What are functional implications of coxa vara?
wide base of support, greater need of STJ to supinate during gait to bring lateral calcaneus to ground
, medial knee tension, lateral knee compression
What are primary hip flexors?
sagittal plane: iliopsoas, sartorius, TFL, rectus femoris, adductor longus, pectineus
What are primary hip extensors?
Sagittal plane: glute max, adductor magnus, bicep femoris, semitendinosus, semimembranous
What is the major force couple in sagittal plane?
hip extensors and abdominals
posterior pelvic tilt
What are primary external rotators?
transverse plane: glute max, piriformis, QF
What are ER in hip similar to in the rest of the body?
Rotator cuff as they provide joint compression
What is important to remember about ER of hip?
their action depends on position of the femur for example if hip is flexed over 90 most become IR
What are primary adductors in frontal plane?
pectineus, adductor longus, gracilis, adductor brevis, adductor magnus
Why are adductors strains so prevalent?
because the are under constant triplanar biomechanical demand as they are working maximally throughout ROM
What are primary frontal planes abductors?
glute med, glute min, TFL
How much BW equivalent is required to prevent Trendelenburg during SLS?
2 times
What can tears in glute med and glute min be commonly diagnosed as?
trochanteric bursitis
What are best exercises for glute med?
side bridge/plank, SL hip ABD, SLS, lateral band walk, hip hike
What are best exercises for glute max?
bird dog, unilateral bridge, SLS, SLDL, front plank with Hip ext, glute squeeze
